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Home My WebLink About0040 BIRCH STREET - Health 40 Birch Street,Hyannisnort A=245-135 J t �K77td---J WN OF BARNSTABLE cs LOCATION !t , 1� SEWAGE # Y-1 A VILLAGE IIYA4J?.tjta,?��t.j ASSESSOR'S MAP & LOTIf S'— INSTALLER'S NAME & PHONE NO.�G,�1 t��w s' 1 GfinJ-5-5— 9',Jf SEPTIC TANK CAPACITY 15oo19 / e LEACHING FACILITY:(type) `T f (size) NO. OF BEDROOMS `PRIVATE WELL OR PUBLIC WATER BUILDER OR WNM f Fes. L f� DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: '' I VARIANCE GRANTED: Yes No .f t s V q f// �5 No.......1._ .68 1 Fxs.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABL.E Alip irFativaa for Di-nViiii al Wor1w (fuaa,itraurtiuu Urrutit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: ................................................................. ............. . as ion-:\ddress or Lot No. wner a U Qw-»1 w ,y Address ✓ ............................... ems ------------------------------- - - •-•--- ---•---• --------•- --------------------------------------------- s aller Address U Type of Building / �� Size Lot............................Sq. feet Dwelling—No. of Bedrooms,----------- --------------_-._Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons--------------------------- Showers � YP g :-::------------------------ ----------�--- ( ) — Cafeteria ( ) d Other fixtures ..::;_---- _---•------------------ •---------•-- -•---•-------- -- W Design Flow...................5 ::'___.____gallons per person per day. Total daily flow----------------- _®_ ..__.........__gallons. WSeptic Tank—Liquid capacity/ ..gallons Length- ---- -------- Width--.-_ ..____---. Diameter-----.---------- Depth................ x Disposal Trench—No. ........ Width.............. Total Length:...._�!� ......... Total leaching area....................sq. ft. Seepage Pit No.............._------ Diameter.:...--------------- Depth below inlet...e;>-E_._ Total leaching area..................sq. ft. Z Other Distribution box O Dosing tank ( ) aPercolation Test Results Performed bY.................................•-------•---•......---••--•••----------_. Date........................................ Test Pit No. I----------------minutes,per inch Depth of Test Pit-------------------- Depth to ground water........................ (.Zq Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water.-._-_-_-_.-__--_-__._. P4 0 Description of Soil........................................... .:...............................•-•---------- ----••-•----------------------.....•-••------••-•--•-••---••--=---.--••- U ....................................................... UNature of Repairs or Alterations—Answer when-applicable ._ 1--.-___� ®... -s- Agreement•. k5e � �5 a p_ cJ,cr-.7mr a� 7ee� C,-"'!�N aCC0/a -t elpfY,ccf%t J�ti.. NOr.�, The undersigned agrees to install the aforedescribed;Individual Sewage Disposal System in accordance with BLa� the provisions of TITLE 5 of the State Environmental Code The undersigned further agrees not to place the c s stem in o eratio� til a Certificate of Compliance as been'iss d the board of health. �� ,�� Signed .. � e Application.Approved BY ........... ................ - ---------- -------- -, 7 ......Dace.... ............ Application Disapproved for the following reasons- -------------------------------------------------------------------------------------------------------------------------------- 101 ` Dace Permit No. �f�..---4 .9/ Issued 3 ,2 9s Dace a I 0 5— �. THE COMMONWEALTH OF MASSACHUSETTS I BOARD OF HEALTH i TOWN OF BARNSTABLE Appliratiun for DiuVu!3ul Hlurk,i Cnuttutriirtiutt thrmit Application is hereby made for a Permit to Construct ( ) or Repair (.1<) an Individual Sewage Disposal System at: •--•--....`��..... ........��--..._.S.'� �' ....................................`, . ►. r .............................................................. l' - Lo anon- 'Xddress I� or Lot No. -- --- �.. v r Address 1- a' ................_GW�� G� t7 -�'-�-ct.1 (�v.�' 15•y �v► t t �S ___.__41, -•-------------------------••---____._ ..._____ ....................................... nsthllerA2 J8 /�j Address UType of Building (� �/ Size Lot............................Sq. feet ...I - Dwelling—No. of Bedrooms------------�-------------------_._Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons----------.................. Showers ( ) — Cafeteria ( ) dOther fixtures -----------------------------------------------------------_-------------_-----_.......-••.- w Design Flow....................._.7 ...�........__._gallons per person per day. Total daily flow-.__._..... ----..-------•_-gallons. WSeptic Tank—Liquid capacity zalIons Length................ Width-----.---------- Diameter.-.............. Depth................ x Disposal Trench—No, ........Z......... Width.....3.......... Total Length-.-__� ----- Total leaching area....................sq. ft. 3 Seepage Pit No......................'Diameter..................._ Depth below inlet...s :._. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R' ._....-----•----------------••----....--•--••---•-------........-••-------••............----._............................................................... 0 Description of Soil--------------•----------------------------------------------•-•-------------------------------------•-------------------------------------------------......•--••---•- x U w U Nature of Repairs or Alterations—Answer when applicable.---1 1.5_Cam-.-i _...... -p-. �__s ' -----�.-�---- ------ `^^�i✓g. '`= !�o %--�._:L G_-!`� V- � �-` a 6�P •is/(._£n/c�a?_.. .... . --- - -r --- Agreement: �Z✓�> die �/C'r•�f�' �Cv� 2�� '1�� wc�. c,crC�iP, t-4 �'�prlv�l— )Oln.. NJrMco, The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with ef-, the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the G system in operation nil a Certificate of Compliance as been issue b the board of health. Signed - -- .....1.../r/i ----------------- -------- ...----------- - Dace Application.Approved By '�'c-F-.�•--�J �.- y � --- 71 - Dare Application Disapproved for the following reasons- ----------------------------` ....................._............. .. ......... . ................ -- -------------------------------------------------------------------------------------------------------------- ----------- ---------------------------------------------------------------------------- ------------------------------------- Permit No. .' .....Gf1- _'..�-' I Issued ........... . -7.�7 9S_.....Dare..... Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH \� TOWN OF BARNSTABLE Tertifi ate of CoznlaIiance THIS IS TO CERTIF_)�_That the Individual Sewage Disposal System constructed ( ) or Repaired C' r.[S ice✓c�-(vr.1 �, Inuallcr �a� c /fL( �'T�'L.�£_ y f - `�✓��N/1 16 1�i✓Z, at .. ................................................_....... ----------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as des ribed in the application for Disposal Works Construction Permit No. .�-.r.--.�.�./...__...._. dated ..... �` THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. f DATE...../�� ----- _.. .... _... - Ins ec -----� ?P .... THE COMMONWEALTH OF MASSACHUSETTS 7 5 ( BOARD OF HEALTH -- TOWN OF BARNSTABLE No........................ FEE FEE.........................Turku �uii,�iri�rtuan �rriatit • Permission is hereby granted-------------------------�-�--�:? `-._��_'77.__..__..00 "I s��rL'J ....----•-•---•-..........•-•--••................................. to Construct ( ) or Repair ( [>an Individual Sewage Disposal System at No. 6 •��/!r y"_.._.__.. T�� £---- � f�......� ---••---....... Street ec,, _ as shown on the application for Disposal Works Construction Permit No.1._�� ......_ Dated...... �Z��.......... f3 Board of Health DATE........—' �•--••-••---••--------•-•......-----•..... FORM 36508 HOBBS 6 WARREN.INC.,PUBLISHERS V BORTOLOTTI CONSTRUCTION, INC. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address Prop Date of�spgc} MapL/� /e21 Owner ✓ lei C�.Ialelz? PART A - CHECKLIST CHECK IF THE FOLLOWING HAVE BEEN DONE: V PUMPING INFORMATION WAS REQUESTED OF THE OWNER,OCCUPANT,AND BOARD OF HEALTH. NONE OF THE SYSTEM COMPONENTS HAVE BEEN PUMPED FOR AT LEAST TWO WEEKS AND THE SYSTEM HAS BEEN RECEIVING NORMAL FLOW RATES DURING THAT PERIOD. LARGE COLUMES OF WATER HAVE NOT BEEN INTRODUCED INTO THE SYSTEM RECENTLY OR AS PART OF THIS INSPECTION. V//CS—BUILT PLANS HAVE BEEN OBTAINED AND EXAMINED. NOTE IF THEY ARE NOT AVAILABLE WITH N/A. THE FACILITY OR DWELLING WAS INSPECTED FOR SIGNS OF SEWAGE BACK—UP. — E SITE WAS INSPECTED FOR SIGNS OF BREAKOUT. TH Z-1�ALL SYSTEM COMPONENTS,EXCLUDING THE SAS,HAVE BEEN LOCATED ON THE SITE. �4HE SEPTIC TANK MANHOLES WERE UNCOVERED,OPENED,AND THE INTERIOR OF THE SEPTIC TANK WAS INSPECTED FOR CONDITION OF BAFFLES OR TEES,MATERIAL OF CONSTRUCTION,DIMENSIONS,DEPTH OF LIQUID,DEPTH OF SLUDGE, D PTH OF SCUM. THE SIZE AND LOCATION OF THE SAS ON THE SITE HAS BEEN DETERMINED BASED ON EXISTING INFORMATION OR /THE APPROXIMATED BY NON—INTRUSIVE METHODS. FACILITY OWNER(AND OCCUPANTS,IF DIFFERENT FROM OWNER)WERE PROVIDED WITH INFORMATION ON THE PROPER MAINTENANCE OF SSDS. PART B - SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL No of Bedrooms Z— No of Current Residents —_ �'� Garbage Grinder Laundry Connected to System y y /lid Seasonal Use NON RESIDENTIAL: Calculated flow WATER METER READINGS,IF AVAILABLE: -------------- ----------_. ... - GALLONS Pumping Records and Source of Information: S SYSTEM PUMPED AS PART OF INSPECTION? IF YES,VOLUME PUMPED = GALS Reason for Pumping: TYPE OF S STEM: Septic tank/distribution box/soil absorption system Cesspool _ Overflow Cesspool _ Shared system (if yes,attach previous inspection records, if any) Other(explain) , ----------im-pon --- ----a,---.---------.-- ------.-------.-- -- --... ----- ----- -- ------------- Approximate age of all components. Date installed,if known. Source of information. Vb 7fg5' SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE? /v V r - -= SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B — SYSTEM INFORMATION (Continued) SEPTIC TANK: Depth below grade: ,2 i/ Dimensions: , —G S-Wxill Material of construction: Concrete Metal FRP Other} Siudge Depth Q Distance from top of sludge to bottom of outlet tee or baffle Scum Thickness Distance from Top of Scum to top of outlet tee or baffle Distance from bottom of Scum to bottom of outlet tee or baffle Comments: DISTRIBUTION BOX: G 5 DEPTH OF LIQUID LEVEL ABOVE OUTLET INVERT Comments: f PUMP CHAMBER: Pumps in working order? Comments: SOIL ABSORPTION SYSTEM (SAS): y e5 IF NOT PRESENT,EXPLAIN: ,�1 TYPE: 1` 70 �liA�w Comments: pp CESSPOOLS: Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimension of cesspool Materials of construction Indication of groundwater inflow(cesspool must be pumped) Comments: PRIVY: 7,14 Materials of construction Dimensions Depth of solids Comments: I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B — SYSTEM INFORMATION (Continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: INCLUDE TIES TO AT LEAST TWO PERMANENT REFERENCES, LANDMARKS OR BENCHMARKS. LOCATE ALL WELLS WITHIN 100' 1 � � DEPTH TO GROUNDWATER: DEPTH TO GROUNDWATER METHOD OF DETERMINATION OR APPROXIMATION: e7 fel�i�o/ • -` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C — FAILURE CRITERIA (Indicate Y—yes N—no ND—not determined.Describe basis of determination.If"not determined",explain why not.) Backup of Sewage into Facility? Discharge or ponding of effluent to the surface of the ground or surface waters? N Static liquid level in the districution box above outlet invert? !� Liquid depth in cesspool, 6"below invert or available volume, 1/2 day flow? /" Required pumping 4 times or more in the last year? Number of times pumped _AL Septic tank is metal?cracked?structurally unsound?substantial infiltration? substantial exfiltration? tank failure imminent? Is any portion of the SAS,cesspool or privy, below the high groundwater elevation? Within 50 feet of a surface water? Within 100 feet of a surface water supply or tributary to a surface water supply? Within a Zone I of a public well? Within 50 feet of a private water supply well? _Al Within 50 feet of a bordering vegetated wetland or salt marsh (cesspools &privies only, not the SAS)? _. Less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,amonia nitrogen and nitrate nitrogen. PART D — CERTIFICATION INSPECTOR: ROBERT J. BORTOLOTTI ADDRESS: 765 WAKEBY ROAD, MARSTONS MILLS COMPANY: BORTOLOTTI CONSTRUCTION INC. MA 02648 (508) 771-9399 CERTIFICATION STATEMENT I CERTIFY THAT I HAVE PERSONALLY INSPECTED THE SEWAGE DISPOSAL SYSTEM AT THIS ADDRESS AND THAT THE INFORMATION REPORTED IS TRUE,ACCURATE AND COMPLETE AS OF THE TIME OF INSPECTION. THE INSPECTION WAS PERFORMED AND ANY RECOMMENDATION REGARDING UPGRADE,MAINTENANCE AND REPAIR ARE CONSISTENT WITH MY TRAINING AND EXPERIENCE IN THE PROPER FUNCTION AND MAINTENANCE OF ON—SITE SEWAGE DISPOSAL SYSTEMS, CHECK ONE: I HAVE NOT FOUND ANY INFORMATION WHICH INDICATES THAT THE SYSTEM FAILS TO ADEQUATELY PROTECT PUBLIC HEALTH OR THE ENVIRONMENT AS DEFINED IN 310 CMF 15.303. ANY FAILURE CRITERIA NOT EVALUATED ARE AS STATED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. I HAVE DETERMINED THAT THE SYSTEM FAILS TO PROTECT PUBLIC HEALTH AND THE ENVIRONMENT AS DEFINED IN 310 CMR 15.303. THE BASIS FOR THIS DETERMINATION IS PROVIDED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. INSPECTOR'S SIGNATURE: G DATE: ORIGINAL TO SYSTEM OWNER,COPIES:BUYER(if applicable),APPROVING AUTHORITY — —— —